Treatment 3.0 Flashcards
Indications for proning?
How many people does it require?
For patients in ARDS (last ditch effort to get VQ matching)
requires 4-6 people
Contraindications to proning
- facial trauma, or open wound in chest or abdomen
- unstable spinal cord injury
- controlled cerebral hypertension
Precautions to proning
- Hemodynamic instability
- active intra-abdominal processes
Proning procedure
- slide patient away from ventilator side
- position arms close to or slightly on top of body
- place 4 pillows on legs, hips, belly and chest, wrap all together in sheet
- two way roll to prone, untangle arms and sheet
- place arms in cactus position, head in R or L rotation, change position every 2 hours, can be prone for 2-10 hours
Purpose of percussions
remove secretions
Percussion procedure
used cupped hands, in conjunction with other techniques, check skin before and after for redness; duration: 2-5 minutes
Percussion contraindications/precautions
- # ribs
- prone to hemorrhage
- metastatic bone cancer
- osteoporosis
- burns,
- subcutaneous emphysema of neck and thorax
- poor/unstable CV condition
- recent skin graft or flap
- resectable tumor
- pneumothorax
Vibrations purpose
Remove bronchial secretions and improve tidal volume
Vibrations procedure
done on exhalation, in conjunction with other techniques, duration: 5 minutes * can use mechanical vibrator machines but they are not very effective (may be appropriate for fragile patients: osteoporotic, or elderly `
Rib springing purpose
to to increase chest expansion and therefore a bigger inspiration
Rib springing procedure
chest compression followed by overpressure and quick release at end expiration, can be combined with percs and vibs
Indications for manual hyperinflation
acute lobar collapse and sputum clearance
What do you need for manual hyperinflation
Ambu bag, O2 tubing, pressure manometer (cannot go over 30-40 cm H2O), skill
Contraindications to manual hyperinflation
- acute pneumonectomy (unless surgeon says yes)
- undrained pneumothorax
- proximal tumor or obstruction
- unstable head injury
- HFOV
Precautions to manual hyperinflation
Hemoptysis Bullae High RR PEEP Severe bronchospasm CVS instability
Indications for active cycle of breathing
for secretion removal, allow inc pressure behind the huff, not forceful at all
Active cycle of breathing procedure
have patients do this 15-20 minutes per day
- normal breathing for 1 minute
- deep breathing for 3-4 breaths, and hold 3 seconds
- normal breaths for 2-3 breaths
- huff: medium breath in and repeat 2-3 times
- if sputum not produced go back to normal breathing and repeat, if sputum, then repeat huff 2-3 times
- repeat 10-15 x or for 15 minutes * if two have gone by and have not been productive don’t continue*
Autogenic drainage indication
alter rate and depth of breathing to produce highest possible airflow in bronchi while maintain stability
Autogenic drainage stages
Unsticking
Collecting
Evacuating
Autogenic drainage procedure
- slow diaphragmatic breathing slow breaths, take slightly deeper breaths than normal, then exhale normally for 10-20 breaths, then take 10-20 breaths at a higher lung volume
- try not to cough, then practice coughing and huffing, takes longer 30-45 mins, 2x a day
Positive expiratory pressure indications
one-way valve mask that creates resistance on expiration, to keep airways open to get behind mucus via collateral airways and help secretion
Positive expiratory pressure procedure
Inspiration 5-10 times with active exhalation at 1:3 or 1:4 usually followed by huffing or FET
- can also do two cycles then go back to percussion
What is oscillating PEP? What population is it commonly used in?
- handheld device that oscillates and vibrates during inspiration that will help dislodge mucous in the small and large airways
- *used in CF patients a lot (acapella, PEP with flutter)
What are the different types of suctioning
- Indwelling or not
- Trach, nasopharyngeal, oral pharyngeal
- Sterile, modified sterile, clean technique
What are the suctioning pressures for adults, children, and infants?
Adults: 120-150mmHg
Children: 80-120 mmHg
infants: 60-80 mmHg
What is the indications for suctioning
- patient can’t clear secretions
- loss of airway control
- lung pathologies
- obtain sputum sample
Contraindications to suctioning
- worsening clinical conditions
- nasopharyngeal: basal skull #, nasal bleeding or bleeding disorders, epiglottitis or croup, CSF leakage, nasal stenosis
What are 3 outcome measures used in pulmonary rehab
Dyspnea scale 0-4, measure of functional dyspnea
BORG breathlessness scale 0-10, dyspnea during activity
RPE 0-10, fatigue or breathlessness in muscles
Aerobic exercises prescription for pulmonary rehab
1-2 x per day to 3-5 days per week, interval training (5-10 minutes, 2-5 min rest work up to 10-40 mins of continuous exercise), dynamic activity using large muscle groups
Strength prescription for pulmonary rehab
- 1,3, or 10 reps, respiratory muscle retraining, functional (TUG, BERG)
- light weight higher reps, 1-5 lbs. (tubing) for 8-10 reps, 50-80% max strength
For all exercises…
SpO2 should not fall under _____
Borg should not exceed ____
No abnormal changes in….
No presence of …
88%
5
rhythm, heart rate;
no pain, nausea, dizziness or headache, monitor blood sugar
